Best Practice for Long-Term Central Venous Access and Management of Complications

  • R. Cartland BurnsEmail author
Reference work entry
Part of the Organ and Tissue Transplantation book series (OTT)


Secure, durable, reliable vascular access has become one of the most central requirements for continuing management of children with Intestinal Failure and the need for continuing parenteral nutrition. The secure placement and maintenance of vascular access devices has many potential vulnerabilities including inadequate vascular anatomy, infection, catheter dislodgement or damage, fibrin sheath, and many others. The modern ability to maintain these implanted devices for many years stands as a testimony to the multidisciplinary efforts that have addressed each aspect of vessel and catheter preservation. In most institutions regularly treating children with intestinal failure, guidelines have been proposed regarding the placement of catheters, the types of catheters used, and the care and use of the catheters. This continued strict adherence to protocols has been shown to have dramatic effects in extending the lifespan of a useful catheter.


Catheters Intestinal failure Parenteral nutrition Vascular access 


  1. Abu-El-Haija M, Schultz J, Rahhal RM (2014) Effects of 70% ethanol locks on rates of central line infection, thrombosis, breakage, and replacement in pediatric intestinal failure. J Pediatr Gastroenterol Nutr 58(6):703–708PubMedGoogle Scholar
  2. Anderson DM et al (2013) Alteplase for the treatment of catheter occlusion in pediatric patients. Ann Pharmacother 47(3):405–409CrossRefPubMedGoogle Scholar
  3. Anton N et al (2009) Heparin-bonded central venous catheters do not reduce thrombosis in infants with congenital heart disease: a blinded randomized, controlled trial. Pediatrics 123(3):453–458CrossRefGoogle Scholar
  4. Chong LM et al (2013) Maintenance of patency of central venous access devices by registered nurses in an acute ambulatory setting: an evidence utilization project. Int J Evid Based Health 11(1):20–25CrossRefGoogle Scholar
  5. Cober MP, Kovacevich DS, Teitelbaum DH (2011) Ethanol-lock therapy for the prevention of central venous access device infections in pediatric patients with intestinal failure. J Parenter Enter Nutr 35(1):67–73CrossRefGoogle Scholar
  6. Gupta H et al (2007) Evaluation of pediatric oncology patients with previous multiple central catheters for vascular access: is Doppler ultrasound needed? Pediatr Blood Cancer 48(5):527–531CrossRefPubMedGoogle Scholar
  7. Hooke C (2000) Recombinant tissue plasminogen activator for central venous access device occlusion. J Pediatr Oncol Nurs 17(3):174–178CrossRefPubMedGoogle Scholar
  8. Kerner JA Jr et al (2006) Treatment of catheter occlusion in pediatric patients. J Parenter Enter Nutr 30(1 Suppl):S73–S81CrossRefGoogle Scholar
  9. Lok CE, Foley R (2013) Vascular access morbidity and mortality: trends of the last decade. Clin J Am Soc Nephrol 8(7):1213–1219CrossRefPubMedGoogle Scholar
  10. Mitchell MD et al (2009) Heparin flushing and other interventions to maintain patency of central venous catheters: a systematic review. J Adv Nurs 65(10):2007–2021CrossRefPubMedGoogle Scholar
  11. Pittiruti M et al (2009) ESPEN guidelines on parenteral nutrition: central venous catheters (access, care, diagnosis and therapy of complications). Clin Nutr 28(4):365–377CrossRefPubMedGoogle Scholar
  12. Rowan CM et al (2013) Alteplase use for malfunctioning central venous catheters correlates with catheter-associated bloodstream infections. Pediatr Crit Care Med 14(3):306–309CrossRefPubMedGoogle Scholar
  13. Samoya SW (2010) Real-time ultrasound-guided peripheral vascular access in pediatric patients. Anesth Analg 111(3):823–825CrossRefPubMedGoogle Scholar
  14. Wales PW et al (2011) Ethanol lock therapy to reduce the incidence of catheter-related bloodstream infections in home parenteral nutrition patients with intestinal failure: preliminary experience. J Pediatr Surg 46(5):951–956CrossRefPubMedGoogle Scholar
  15. Wong T et al (2012) Central venous catheter thrombosis associated with 70% ethanol locks in pediatric intestinal failure patients on home parenteral nutrition: a case series. J Parenter Enter Nutr 36(3):358–360CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Riley Children’s Hospital, Indiana UniversityIndianapolisUSA

Section editors and affiliations

  • George Mazariegos
    • 1
  • Dale Zecca
    • 2
  • Jennifer Melvin
    • 3
  1. 1.Hillman Center for Pediatric TransplantationChildren’s Hospital of Pittsburgh of UPMCPittsburghUSA
  2. 2.Children’s Hospital of PittsburghPittsburghUSA
  3. 3.Children’s Hospital of PittsburghPittsburghUSA

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